We Asked a Pediatrician About Your Most Common Questions and Concerns
John Farrell, M.D., FAAP, is a pediatrician in private practice in Herndon, Va. We talked with him about the most common questions and issues that new parents raise — and the advice that he offers them during the first weeks after a baby is born.
Q: Do most parents you see try to breast-feed?
A: At least 90 percent of our new moms are trying to breast-feed, which is great, so our biggest role is to promote good breast-feeding. One of our most common referrals is to a lactation consultant, and this is after spending a lot of time going over all the feeding issues. Really it's fairly basic advice, following children's input and output, how to get the baby latched on, and so on.
There's a fear of breast-feeding, and unfortunately it seems to be potentiated through other moms. Complete strangers will come up to you and tell you how hard it is to breast-feed, or unfortunately, through previous generations, where everyone was formula-fed. I find there's a lack of support from a lot of grandparents about breast-feeding. The sixties and seventies were the formula age, and unfortunately it was a confusing time. Even pediatricians were recommending formula then. So sometimes there is a real lack of support for it. Parents come in when they're finally faced with this little creature and actually getting them to nurse, and they aren't really sure there's anything in there. It creates a lot of problems.
Q: What tips do you give new moms who are trying to nurse?
A: First, I usually see parents in the hospital. The first thing I tell parents is that the baby's going to fall asleep for the first 24 hours of life. You've just had a baby and you're full of adrenaline, and the baby's full of adrenaline and it's going to stay awake for about an hour. So if you can get the baby to latch on in that first hour you've proved to yourself that neurologically everything is there — he can suck and swallow and that kind of thing. Then they usually fall asleep.
Nurses in the hospital are trained to try to get the baby on to the breast every two to three hours, and sometimes the message that comes across to the parents is that the baby has to eat every two to three hours, and that's not the case. So on that first day I can usually fend off some anxiety by saying to them, "I expect him or her to sleep for the next 23 hours after birth." And often they say, "Phew, I thought she had to feed every two hours," and right there breast-feeding is set up to fail on that first day.
If you can get in there early and tell parents what's normal, what to expect, then you can take away that anxiety. I think a lot of [breast-feeding difficulties] have to do with anxiety, and if you can reduce that anxiety it just works out so well, which is evident by the second and third child, when everyone knows what they're doing and the breast-feeding goes so much better. The more anxious a mom is, the longer time it takes for the milk to come in. There's a whole mental side to breast-feeding. If you're very anxious, you're not going to have an adequate let-down. If you don't feel like you're providing this nutrient to your child, it's probably not going to happen. Reassuring new breast-feeding mothers is a huge part of what I do.
Some parents come in having read everything. I call them "over-read." They come in and say, "I'm going to breast-feed for the first year because that's what everybody says." But if you start off on Day One saying you're going to breast-feed for a year, that's kind of daunting. Whereas if you just set little goals, saying "OK, I'm going to make it through the first week," then "I'm going to make it through the second week," then "OK, let's shoot for two months," then it's easier.
